I’d heard of Ram Dass, a contemporary spiritual teacher, mainly for his seminal book ‘Be Here Now’ published in 1971 (when it was still weird to meditate). I hadn’t really taken much notice of him until ‘Still Here’ came along nearly thirty years later. He’s worked with the dying and also – more unusually – helped create Circles of Elders in local communities. He didn’t know how to finish his book ‘Still Here’ – and then he had a stroke. It’s a great read on ‘embracing aging, changing, and dying’ – it’s sub-title.
Here’s some quotes from ‘Still Here’ and ‘Ram Dass One Liners’, quotes that resonate with me in second half of life work.
“Aging is a stage in life that’s especially ripe for us to get free.”
“We have to do two things while investigating our own attitudes towards aging. First, look at the underlying question of whether we believe ourselves to be bodies with brain-centered minds and nothing more; and second, ask ourselves, “Can there ever be enough?”"
“Aging represents failure in our society, so each of us looks ahead and sees inevitable failure.”
“Many of us spend our lives worrying about losing what we have. Old age offers the opportunity to shift our cares away from the physical toward what cannot be taken away: our wisdom and the love we offer to those around us. But a culture without spiritual underpinnings deprives us of this opportunity. What Indians experience as a time of liberation is experienced by many Americans as a time of loss.”
“Grief is an integral part of elder wisdom, a force that humbles and deepens our hearts, connects us to the grief of the world, and enables us to be of help.”
“As long as we identify only with things that change, like our bodies, we don’t have a perspective that can free us from our anxiety about aging.”
“There seems to be sequence to the aging process: at first one goes through a feeling of loss, then, if we can be open to that, of new opportunities.”
“One of the best parts of aging is entering the ‘don’t know’, learning to be someone who can rest comfortably in uncertainty.”
…”to age in a conscious way, fearlessness is an essential ingredient. This fearlessness involves the willingness to tell the truth, to ourselves and to others, and to confront the contents of our minds. We must be willing to look at everything – our own suffering as well as the suffering of others – without averting our gaze, and allow it to be in the present moment. Rather than closing ourselves to fear, we learn to open to it, to sit with it, allowing it to arise and pass in its own time. By simply looking, with no push or pull, mindfulness is strengthened. You will find that the moment you enter this witness state, the boundaries of the Ego are loosened, and fear begins to change.”
“One source of our ‘elder wisdom’ is that our desires don’t drive us so much anymore. Desire patterns change, and then new things emerge.”
“The wisdom of aging is nurtured by quietness. We slow down to savour experiences, ‘turning them round in the light’”.
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As soon as I finished ‘How to Meditate’, I started reading it again. I first learnt to meditate in 1987, so I guess that shows this nugget compilation of meditation teachings will appeal to and help long-time meditators. If you’re a beginner, or simply interested, well, what a blessing to have this book at your disposal.
Pema Chodron, born Deirdre Blomfield-Brown in New York City, 1936, became a student of the late Chogyam Trungpa. She is a now a teacher in the Shambala tradition he founded, living at Gampo Abbey, Nova Scotia, and a notable American figure in Tibetan Buddhism. She has been phenomenally successful in making these teachings accessible via her well crafted books.
I’ve often heard it said that it’s best for the most experienced meditators/teachers to teach beginners and feel this book bears that out.
It comes after a long list of what are now, already, spiritual classics such as: ‘The Places That Scare You’, ‘When Things Fall Apart’, ‘Start Where You Are’ and ‘The Wisdom Of No Escape’. The sub-title of this book, ‘A Practical Guide To Making Friends With Your Mind’ continues her prosaic yet skilful tradition of great titles. And it delivers.
Part one introduces the technique of meditation. Parts two and three, on working with thoughts, and working with emotions, contain some of the clearest and pithiest advice on these tricky areas that I’ve come across. If you start out meditating, thinking it’s about always feeling good, you’re setting yourself up for failure as well as misunderstanding what it’s about (in this tradition anyway). Even the most settled meditator experiences physical and psychological pain. Part four, on ‘working with sense perceptions’, and part five, ‘opening your heart to include everything’ are, perhaps, addressed to the more experienced.
As in all her books, she has a light touch and a cheerful attitude. What I appreciate above all is simply how human she is, not just about others, “Meditators have moods too”, but also herself. How refreshing for a teacher to share (the example is while looking after her six year old grand-daughter) that she too ‘acts out’ on occasion – as we all do – and how to best respond to that. “One of the many boons of meditation is that it helps us take an interest in our life in a way that is curious and expansive, rather than seeing life’s complexities as a constant struggle.”
Pema Chodron stresses that this is a book on samatha meditation, a word meaning ‘calm abiding’. (Buddhist meditation comprises samatha and vipassana – insight into the true nature of reality. The idea being that you need to be steadfast in order to effectively explore.) There’s a good dose of enquiry type material in this book too, which I really appreciated, especially on the messier side of life and meditation practice.
“All of us will reach a very interesting point in our practice when we hit the brick wall. It’s inevitable… I love to talk to people when they’re at the point of the brick wall: they think they’re ready to quit, but I feel they’re just beginning. If they could work with the unpleasantness, the insult to ego, the lack of certainty, then they’re getting closer to the fluid, changing, real nature of life.”
Learning to meditate is simple really – though not easy. Why do it? The nutshells are as good as the book titles. “The motivation behind meditation is not to get rid of thoughts, but to train the mind to reclaim its natural capacity to stay present… we’re training to bring out the mind’s natural wakefulness.”
She adds, just like the Buddha did, don’t take my word for it – test it with your own experience. “It takes quite a while,” Pema notes, “to see that you actually can be awake and present and live your life in a creative and engaged way without letting your mind wander all the time.” So, it may take ‘quite a while’ – and it can be done. You don’t have to be a Buddhist to learn to meditate, or to benefit from using this book as a guide. To use a well known double entendre – meditation is not what you think. It helps to read a book – and it isn’t reading a book either! Give it a go.
‘How to Meditate: a practical guide to making friends with your mind’ by Pema Chodron, Sounds True, 2013.
Learn to Meditate workshop, Sun 7 Sept (and 7 Dec), 10am-5pm.
An 8 week Mindfulness course starts Thurs 4 Sept 6.30 – 9pm.
All at Melin Pant-yr-Ynn, Blaenau Ffestiniog. Visit www.janparker.co.uk for more info and to book.
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I’m writing this to give you a heads up about Lord Falconer’s Assisted Dying Bill and to ask you to support it.
The bill- briefly introduced last May 2103 – gets its second reading sometime this spring/summer, which means it will be properly debated this time and could go further. I hope so. I agree with Betty (now Baroness) Boothroyd who recently said “This is a moral issue whose time has come“.
The current UK law is an mess which denies the freedom to individuals to take well considered and dignified steps to end their own lives in order to avoid overwhelming misery and suffering. It really is as simple as that. The debate will go in a zillion different directions and there’ll be plenty of scare-mongering from opponents of the Bill. For me, the core principles and motivation behind this proposal are compassion and respect and the details of the Bill allay concerns over potential abuse. As Schopenhauer said “… there’s nothing over which a person has an indisputable right more than their own life”.
The first attempt to change the UK law along these lines was in 1935, drafted by the Voluntary Euthanasia Legalisation Society (VELS) in its first year. The following year, as he lay comatose on his deathbed, George V was injected with fatal doses of morphine and cocaine to assure him a painless death. This fact was kept secret for fifty years. The King’s doctor spoke out against a change in the law – he didn’t think it was wrong, he thought it should be the doctors that decide.
Things have and haven’t changed since then. Representatives of medical bodies are mostly still against a change in the law, though various polls of individual doctors show a different personal response and a desire for their medical representatives to adopt a position of neutrality. That the BMA refused a request in 2013 (from Healthcare Professionals for Assisted Dying) for a survey of its members views speaks volumes to me… Church leaders are opposed to assisted dying – and at odds therefore with the majority of their flocks (see below).
Buddhist ethics are based on precepts, training principles, not rigid rules or commandments. Number one is to love and protect life. In buddhism, mind is primary and so the intention behind an action is as -if not more – important than the action itself. Assisted dying is for people who are already dying choosing to end suffering ; it’s not about a hatred of life.
Public opinion polls have shown a majority in favour of a change in the law for some time now. The latest (YouGov) poll shows 76% in favour of Lord Falconer’s Bill. Please don’t be a silent member of this majority. Gen up on the issues and start talking about them, including with your doctor and MP. A great place to start is by going to www.dignityindying.org.uk to find out more about Lord Falconer’s Bill. Sign up for their newsletter and give them some money while you’re at it!
The VELS that began in 1935 morphed into Dignity in Dying in 2005 – and refined its core aim to focus on campaigning for assisted dying for terminally ill, mentally competent adults. It was so overwhelmed with public enquiries and the need for information about choices and rights at the end of life, that it set up Compassion in Dying to deal with that, and to enable it to re-focus on campaigning. (Compassion in Dying are also the leading provider of free advance directives in the UK www.compassionindying.org.uk).
Changing a law helps change the culture of a society. Trying to change a law begins that cultural change. We can all be a part of that. Simply talking more about death helps to normalise it. It doesn’t bring it on!
The BBC’s Coronation Street got the nation talking in January with a storyline about character Hayley Cropper (I resist an obvious joke here) being diagnosed with inoperable cancer and deciding to committ suicide. Nine million watched her final episode. If you want to know more about that click on this link http://www.ehospice.com/uk/ArticleView/tabid/10697/ArticleId/8493/language/en-GB/View.aspx
I don’t watch soaps but I did hear about Hayley and the right-to-die debate all over the media. Let’s hope that bodes well for more change to come in 2014. Please play your part. Thanks for reading this. May the fear and reality of dying in misery and suffering become a thing of the past.
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A friend tipped me off about this 11 minute TED talk. http://www.ted.com/talks/jane_fonda_life_s_third_act
I call it ‘the second half of life’. She calls it the third act – but she would, wouldn’t she, she’s an actor… I may feel differently when I get past sixty though, as I say on my second half of life page, it’s not so much about the numbers as where you feel you are on your life path, and what direction you’re facing.
“I realised that, in order to know where I was going, I had to know where I’d been. And so I went back and studied my first two acts.” The process she talks about is similar to some of the work we do on my second half of life w/e’s.
Jane comes up with a beautiful image for the process of ageing – I hope some of you join me on the staircase this year…
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When I learnt to meditate in London 1987 I kept it top secret. I was working in politics and most people in my circle then thought it was a weird, if not cultish thing to do. The most common accusation – and misunderstanding – then, was that it was an ‘escapist’ thing to do.
These days meditation is more mainstream, though there’s still plenty of strange ideas about it. The most common one I’ve come up against, repeatedly, and often in the context of people saying that they just can’t or couldn’t do it, is the idea that meditation is making your mind a blank. The goal, apparently, is to completely stop having thoughts and to maintain that ‘fixed’ state for a long time. (Usually whilst sitting in an impossible, uncomfortable position, legs like a pretzel, with forefingers and thumbs touching each other to create a circle.) Meditation is much more interesting than that.
Minds produce thoughts – it’s what they’re built for – and keep producing them even when you’re meditating. You can still become calm and settled by learning to let thoughts go. And exploring your thoughts lets you see what’s bugging you, and even how your mind really works.
It’s fairly straightforward to get started in meditation. It helps to be clear about what it is. It will certainly help you to keep going if you are clear about your purpose for doing it. We meditate with our bodies as much – maybe more – than with our minds. That’s part of the on-going practice and for starters we each need to find the best posture to do it in. If you don’t have pretzel legs, sitting in a chair is fine.
Then we learn a technique (or more than one). And then we have the rest of our lives to develop this art, as that’s what meditation is really, it’s not a technique, it’s a way of being.
It takes courage to meditate – courage, gentleness, and a sense of humour. Ultimately meditation is about allowing ourselves to be who we truly are. Rather than striving to achieve an ideal state of mind, or somehow becoming a better version of ourselves, we begin to discover the delights of making friends with ourselves as we are.
I’m profoundly grateful to all the people who made it possible for me – in a crazy stressed out state in one of the busiest cities in the world – to end up learning how to meditate. It saved my life and I know many others who feel the same. I’m an imperfect practitioner. I don’t beat myself up about that any more. I’m passionate about doing what I can to help create a meditative culture here and now.
Meditation is a completely normal thing to do. Just about everyone can do it and learn to do it. Throughout history it’s been a core ingredient of traditional cultures and religions all over the world. Meditation is probably more important for us than any other people in history because the pace of life is getting faster and faster. Human beings are wired for being as well as doing, for periods of stillness, aloneness and silence. We need this practice simply to be fully human and to help our communities and society to run smoothly.
The current boom in the modern secular mindfulness movement is a response to this need. There’s concern in some parts of the buddhist world about this removing mindfulness from its full and proper context but buddhism doesn’t own mindfulness. I say ‘bring it on’.
There are many forms of meditation. Mindfulness – which can be summed up as a training in attention – is a core practice. It’s a great place to start. It’s a great ‘place’ to stay! If you need scientific validation of the benefits of mindfulness to encourage you to give it a go, there’s 30 years of research now to back up how it helps people with a range of issues from stress, pain, anxiety and depression.
Mindfulness is making its way into the NHS and other healthcare settings, nudging medication out of the way – how cool is that. Corporate executives are using it to help with stress. (I dream that someone will subsidise courses to help single parents on benefits deal with their stress.) Chris Ruane, MP for the Vale of Clwyd in north Wales initiated a debate in the UK house of Commons in December 2012 on mindfulness, especially on how it can help the unemployed.
The BBC reported at the end of February about the mindfulness courses being run at Westminster for MP’s and Lords and there’s a course planned for the Senedd (the Welsh Assembly) too. Even the US marines are using mindfulness as part of their military training – I shall never hear the military command “Attention!” in quite the same way again.
Many of you probably realise that Bangor University is a major hub of mindfulness training in the UK. Hey, there’s even courses in Pwllheli www.gwyneddmindfulness.co.uk and Blaenau Ffestiniog http://www.janparker.co.uk/meditation/ this summer. Mindfulness in the mountains – it’s really going places now……
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I learnt a lot more about Nelson Mandela after he died on 5 December 2013. One of the most inspiring things I learnt about him was his role in bringing together The Elders – an independent group of world leaders who work together for peace and human rights.
Richard Branson and Peter Gabriel came up with the idea after a chat about how many traditional communities look to their elders for guidance, or to help resolve disputes. They were thinking in terms of the ‘global village’ and took their idea to Mandela. With the help of his wife, Graca Machel, and his friend, Desmond Tutu, Mandela bought a worldwide group of Elders together and formally launched ‘the band’ in Johannesburg, July 2007. Mandela was 89.
Elders no longer hold public office. They’re independent of any national government or other vested interest. They’ve earned trust, demonstrated integrity and built a reputation for inclusive and progressive leadership. They’re peace makers and pioneering changemakers. To find out more click on this link http://theelders.org/about
I’m glad the global village has elders. Bring on the day when it’s also local again. I guess you/we could have a chat about that…
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A review, by Jan Parker, of ‘Heal Thy Self: Lessons on Mindfulness in Medicine’ by Saki Santorelli, 1999, Bell Tower, New York (Random House).
“Don’t turn your head. Keep looking
at the bandaged place. That’s where
the Light enters you.” Rumi
The current revolution in mindfulness training is astonishing. There’s a wealth of books now on mindfulness, mostly aimed at the general public rather than the buddhist devotee. Ruby Wax is one of the latest authors. Saki Santorelli is the director of the Stress Reduction Clinic housed in the Centre for Mindfulness in Medicine, Health Care and Society (at the University of Massachusetts Medical School, USA), which the better known Jon Kabat-Zinn founded thirty five years ago.
Saki’s book is 15 years old now yet remains my favourite book on mindfulness because it’s so soulful, poetic, riddled with Rumi. If you’re yearning for a retreat and can’t make it at the moment, spend a few days with this book and it’ll have a similar effect, it evokes so well the process and feeling of intense group practice.
The focus of this beautiful and tender book is not just the healing power of mindfulness, it’s also about the healing relationship between ‘patient’ and ‘practitioner’. The context for exploring the dynamics of this archetypal relationship is Saki taking a group of thirty people (most of whom stay the course) through an eight week programme of Mindfulness Based Stress Reduction (MBSR). People are on the course with a range of ‘conditions’ including workaholism, cancer, and persistent angina.
Several friends of mine run these or similar courses (in the UK), either through the Kabat-Zinn programme that the Bangor university and Oxford courses are based on, or through Breathworks. Many people sign up for these courses because they’ve tried everything else and nothing yet has eased their pain and suffering. They are not usually there because they want to learn how to meditate, and they have to commit to a daily 45 minute practice to stay on the programme.
“this stress reduction is killing me…”
Lucille, one of the ‘patients’, says “this stress reduction is killing me. This is the hardest thing I’ve done in my life.” In the section on week four, he says “by this time in the process, class never really ends”.
In the sixth week there’s an all day retreat of 120 people, 90 more than the current class as some previous punters come back for a top-up of experience and inspiration. It’s free. And in total silence for a whole day. This is the first time most people have had that experience. And this is happening in a hospital ie the wider context includes scores of people who have spent years training to be medical professionals. Mindful of that, Saki quotes Jacob Needleman: “No one ever imagines that self-observation may be a highly disciplined skill which requires longer training than any other skill we know of…….”
the importance of a fully present doctor…
In his foreword Kabat-Zinn comments on how there is still a long way to go in the re-humanising of medicine. It’s encouraging to hear that medical students also attend their programmes and that there’s a growing understanding from doctors how a lack of full presence on their part may have terrible consequences not only for their patients, but for themselves too.
“Almost nowhere in our modern lexicon,” Saki writes, “does the use of the word practice suggest that, side by side with the acquired knowledge of our chosen field, and externally directed activity, we are simultaneously called on to make an active, ongoing effort to work with ourselves inwardly if we are to engage in the full practice of our profession.”
…and a fully present ‘patient’ too
The issue of ‘presence’ and ‘practice’ in the patient-practitioner relationship cuts both ways. There is an increasing – and positive - trend, when people become ‘patients,’ to be less passive, more informed, and more desirous of partnership in the healing process than in past decades. Yet it’s also still sadly the case that “many health professionals point towards this same felt absence of practice when they work as hard as they can in the service of those seeking their care, but find little motivation on the part of people to collaborate actively in their own health, unwilling to engage wholeheartedly in the ‘practice’ of being a patient”.
a co-creative process
I first read this book a few years ago when I was training to be a kinesiologist. The school I trained with, Creative Kinesiology, places as much emphasis - if not more – on developing one’s awareness and sensitivity, as on learning techniques. One of it’s core principles is that the work is a co-creative process. So I found myself especially appreciative of Saki’s exploration of this dynamic relationship, not just as a long-time meditator and meditation teacher, but now as a fledgling kinesiologist too. His approach spoke to me and interested me far more than the classic ‘teacher-disciple’ relationship that I find hard to relate to, especially when rigidly and hierarchically applied.
In a chapter called ‘Going Down’, in the section on week three, Saki writes eloquently and incisively – as always – about this dynamic: “what happens in that alive, open space called the patient-practitioner relationship demands…close attention. It is an embodiment, a direct expression of interconnectedness and interdependence. Beyond a doubt we work on ourselves as a means of helping others and, simultaneously, working with others is a way of working on ourselves….It changes the entire nature of the healing relationship from one of fixing and rescuing, or authority and domination, to one of service, collaborative creativity, and inquiry”.
a new Hippocratic oath?
He later says, in what to me sounds like a much needed modern translation of the Hippocratic oath: “Our privilege and responsibility as servants of the healing arts is to create an environment, provide a method, and inspire people to touch what we, beyond any evidence to the contrary, know is who they really are because we have touched this within ourselves.”
cooking lessons, the dress code…
Saki writes convincingly and sensitively about what mindfulness and meditation is; about the process one goes through, whether its in a minute or a month; and about how even more extraordinary it can be to share that process with other people. “It is obvious,” he comments after a few weeks, “that we are all beginning to cook.” And later he adds: ”here there is only one dress code: Nakedness.”
…and an act of love
Mindfulness is not simply a technique, he reminds us; it’s an act of love. This is an intimate book because it is intimate work, an intimate process. And although “for the most part, this is solitary work”, it’s also the case that “the most powerful outcome of our gathering together was the transformational effect that we had on one another”. It’s my experience – as both ‘patient/client’ and practitioner – that this can happen in a one-to-one kinesiology session too.
“Here there is sickness and suffering,” he writes. “For me to do my job, it is unavoidable and necessary to remember and face this daily….when I do not, the consequences are grave. I find no place to stand, no place to be connected.” Having an illness creates enormous, unanticipated turbulence. It is by no means a smooth road. Mindfulness offers a tool for being able to handle this, a way to open to a gamut of often disturbing events, and associated thoughts and emotions, and it helps us keep our seat through it all, provides a kind of ‘stability’ in the flow of experience.
This pioneering work at the stress clinic – and on mindfulness courses – is not trying to make pain and suffering go away. Rather, it shows people how to move into the stress or pain and begin to look at it, to notice the mind’s reactions, and to let go of that reactivity. And then find that there is inner stillness and peace within some of the most difficult life situations. That can be right in this breath, in this experience. It is, if you like, a meditative version of the discharge principle in various forms of complementary medicine, where something is completed and cleared – as opposed to pharmaceutically suppressing symptoms. And is akin to ‘self-liberation’ in the Vajrayana/tantric tradition in Buddhism.
…the open space
“Caring often asks nothing more than open space,” Santorelli says, in a deceptively simple sentence, because, of course, that needs time, a certain attitude or understanding, and commitment. This is clearly not the currently conventional approach to healing. And it gets better still – for me – when he adds: “Most essentially, this way of working is intended to carry us further away from the world of being sure, into the world of not knowing. To be a professional and to not know seems an oxymoron. Nothing could be further from the truth.” A professional who admits to not knowing everything and is full of love! I’d trust this man with my life. Wouldn’t you?
I’m glad to read of all the clinical trials and scientific studies proving how mindfulness helps reduce the level of pain people report, helps reduce the recurrence of depression, and improves other medical and psychological conditions – not least because most, if not all of us, will suffer one or more of those in our lifetime. I’m glad too because it helps people trust and therefore try it. Yet Saki reminds us there’s a magic and mystery in mindfulness practice too that can’t always be pinned down and proved. And there’s many others, including me, who that appeals to as well.
There are thirty practices outlined in the book. (Which are not listed on the contents page – my sole criticism.) Many of them are other ancient meditation practices (that I know of, from the Buddhist tradition). Mindfulness is the basis for all the practices, as well as a practice in its own right. Without under-estimating what powerful medicine mindfulness is, many of the other practices offered in this book go ‘further’ than mindfulness, though -ultimately – it often amounts to the same thing.
watch the distance boundary-making creates
One practice in the book is called ‘working with the boundary-making mind’. “Whether patient or practitioner,” he writes, “we are always in relationship… Can you feel the critical need for each of us to cultivate a willingness to closely watch the boundary-making mind and to develop an extremely refined tool for understanding with precision this process and the distance it creates? I believe that such deliberate and careful attention is the foundation for the entire healing relationship. This begins with our individual commitment to a disciplined way of understanding the nature of mind and its effect in human interactions. Without this kind of attention, how are we ever going to create more collaborative, mutually responsive health care?” That’s a very good question.
I savoured this book because it joins medicine with meditation. “This is medicine moving into the 21st century,” he asserts. I hope he’s right. With all my heart.
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I’ve had some responses and several conversations with friends about fraility in the last few days. This follows on from my 30 Oct post,
and Peter Saul’s TED talk, about how more and more people are now dying, not suddenly or from a terminal illness, but from organ failure, or after years of dwindling capacity and increasing fraility. It’s the result of increased longevity.
Many of my friends have parents or friends in this situation, or are working as carers. We’ve covered lots of ground in our chats.
One issue is the tipping point. When does someone become frail? What’s the criteria? As with so many other things, there are levels. And here it is, a clinical fraility scale from Dalhousie University:
I found it very helpful. It puts my Mum, for example, in a context. It also helps me to see the journey ahead. Assuming there’s no organ failure. I also work two days a week looking after a now 93 year old gentleman, a real gentleman. Who is becoming increasing frail after every infection he (just about) fights off (with incessant anti-biotics).
Being witness to this poignant decline in someone I love and in someone I’ve grown to love is sad and does have its beautiful moments. The beauty of the human spirit can shine through, perhaps even more strongly.
The iconic photographer of the Vietnam war, Tim Page, wrote in the introduction to Nam, a book of his photographs: “To me, human fraility is rarely portrayed with moving imagery, it remains the domain of the still photograph.”
And the photographer Phillip Toledano has proved that point magnificently in his recent book, which I’ve been so moved by, I wanted to share it with you here www.dayswithmyfather.com
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We live, on average, around 30 years longer than we did 100 years ago. Isn’t that an astonishing sentence. I’m gonna have to read that again.
This means there’s been a big shift in the way people die. How we die has changed beyond all recognition in a single generation. Despite the fact this has happened to one of my neighbours this week, sudden death is rare now. And, though it sounds odd, terminal illness affects more younger people now. Only one in ten of people over 80 years old will, for example, die of cancer. The ‘growth industry’ of death is now in these two areas: organ failure, and dwindling capacity, increasing fraility. One undeniable fact of increased longevity is, at risk of saying the obvious, more old age.
Peter Saul unpacks all this in a TED talk called ‘Dying in 21st century Australia, a new experience for all of us’. He’s a Senior Intensivist who’s been deeply involved in the dying process of over 4,000 patients in the past 35 years. As a result of his experience he revolutionised end of life planning in an Australian hospital – until the funding ran out. It boils down to the fact that on a personal level we need to talk with our elders, and to each other, about what we want and make choices about how we would prefer to die.
About one in ten people will die in an Intensive Care Unit (ICU) in Australia. In America, it’s one in five. (In Miami it’s three out of five!) I don’t know what the stats are for the UK but I imagine the general momentum is the same. ”The stress created in families by dying is enormous,” Saul says, “and you get seven times as much stress by dying in Intensive Care as dying anywhere else. Dying in Intensive Care is not your top option if you’ve got a choice.”
As I write, one of my oldest friends is moving his father from an IC Unit in a hospital into a hospice, so this feels very much a live issue, so to speak. The point is, of course, is that it’s a live issue for increasing numbers of people all the time. At the political level, we need a revolution…
To listen to all of Peter Saul’s 14 minute talk click here:
Meanwhile, some American research published by the Guardian last year reveals that doctors don’t die like the rest of us.
What’s unusual about them is not how much treatment they get compared to others, but how little. They know enough about modern medicine to know its limits. Most medical professionals have seen what’s called ‘futile care’ performed on people ie when doctors bring the cutting edge of technology to bear on a greviously ill person near the end of life. Doctors know enough about death to know what all people fear most: dying in pain and dying alone. They’ve talked with their families and made their choices clear.
The message is – if you can, find a way to die in peace at home, and that pain can be managed better than ever now.
Read the full article here http://www.theguardian.com/society/2012/feb/08/how-doctors-choose-die
and the reaction from British medics here http://www.theguardian.com/society/2012/feb/08/how-to-die-doctors-british
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Fellow Dying Matters member James Norris has created www.DeadSoci.al
a free social media tool that enables you to create a series of secret messages that are only published to your social networks once you die.
“Ensure your digital afterlife is in order” it says on the site. Jeez, I can’t even get my Facebook act together, so it’ll be a while before I use this service….
Nice idea though. And some great blogs too.
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